Increased echogenicity of the endometrium

If a woman notices something unusual inside her body, she must go to the hospital for a check-up. Ultrasound examination is usually used to detect whether there are gynecological diseases. The results of ultrasound examination show whether there is a disease condition through echoes. The endometrium is an area that female friends are very concerned about because the endometrium is closely related to the secretion of estrogen in the female body. But when doing an endometrial examination, the result is increased echo. What's going on?

1. Endometrial Hyperplasia

The endometrium of normal women of childbearing age will undergo physiological thickening during the menstrual cycle. However, if the secretion of ovarian hormones is disordered, it can easily lead to abnormal thickening of the endometrium, namely endometrial hyperplasia. If a woman's hypothalamus-pituitary-ovarian axis is out of balance, or if she is affected by diseases such as polycystic ovary syndrome, the endometrium may be continuously affected by estrogen for a long time, resulting in anovulation. The endometrium is continuously affected by estrogen, without progesterone to counteract it and lacking the transformation from a cyclical secretory phase, and will remain in a state of proliferation for a long time, causing abnormal endometrial hyperplasia. In addition, long-term use of estrogen drugs or taking large amounts of supplements containing animal estrogen before examination, such as royal jelly, can cause the endometrium to be stimulated by estrogen, resulting in abnormal proliferation during ultrasound examination.

Uneven endometrial echo may be caused by incomplete endometrial shedding during menstruation. Before normal menstruation, all parts of the endometrium shed synchronously, completely and rapidly. However, when there is no ovulation, due to the fluctuation of estrogen, the endometrium sheds irregularly and incompletely, and there is a lack of sufficient loss of functional layer tissue, making it difficult to effectively stimulate the regeneration and repair of the endometrium, which can be manifested as uneven endometrial echo on ultrasound images.

Most patients with endometrial hyperplasia found clinically are in menopause or adolescence, among which obese women have a higher probability of endometrial thickening. The clinical manifestations are irregular and heavy abnormal uterine bleeding. Patients may experience continuous bleeding after a long period of amenorrhea, which may be suspected of miscarriage clinically. It may also manifest as shortened cycles and prolonged menstruation, with bleeding time lasting up to 1 month.

Endometrial hyperplasia is a group of gradually progressive diseases. Specifically, it includes simple endometrial hyperplasia (also called simple endometrial hyperplasia), complex endometrial hyperplasia and atypical endometrial hyperplasia. Among them, simple intimal hyperplasia is the mildest, atypical hyperplasia is the most serious and is a precancerous lesion.

2. Endometrial polyps

Endometrial polyps are formed due to factors such as inflammation. They are local benign nodular protrusions of the endometrium and are composed of endometrial glands, stroma and blood vessels. Polyps can be single or multiple, tongue-shaped or finger-shaped, sessile or pedunculated, mostly located at the bottom of the uterus, small ones are 1 to 2 mm, and large ones can fill the entire uterine cavity. Single, smaller polyps generally have no clinical symptoms and are mostly discovered during B-ultrasound or hysteroscopy. Ultrasound images show enhanced echoes and clear boundaries with the endometrium. Multiple or larger polyps mainly manifest as increased menstrual flow and prolonged menstrual periods during the reproductive period, and as irregular vaginal bleeding during menopause.

Endometrial polyps can cause infertility and malignant transformation, but malignant transformation is relatively rare.

3. Endometrial cancer

Endometrial cancer is a group of epithelial malignant tumors that occur in the endometrium. It is divided into adenocarcinoma and squamous cell carcinoma, among which endometrial adenocarcinoma is the most common. Ultrasound images show that there are substantial heterogeneous echoes and uneven endometrium in the uterine cavity. Patients with endometrial cancer have no obvious symptoms in the very early stages and are not easy to be detected; as the disease progresses, symptoms such as vaginal bleeding, vaginal discharge, and pain will appear.

Ultrasound is the main auxiliary examination method for gynecological diseases, but ultrasound examination is only an imaging examination and cannot replace pathological examination. In the early stages of certain diseases, when ultrasound manifestations are atypical, ultrasound diagnosis is somewhat subjective and different doctors may have different diagnoses.